Moving to a provider-facing strategy

by David Lanskyon January 06, 2011

George Lakoff, the well-known UC Berkeley linguist, got started thinking about conceptual metaphors by listening to all the ways we talk about our relationships as “a journey." Sometimes our journeys are “on the right track," “going somewhere," or “heading in the right direction." But sometimes we “spin our wheels”, or “fall off the rails."

At PBGH, we’ve been on a journey too – and for the last few years, our work in the California health care marketplace has felt more like “spinning our wheels” than “heading in the right direction.” The things we care most about – achieving better health outcomes, improving the quality of care experienced by patients and keeping health care affordable for working people – are not showing much progress. We continue to rely on a set of mediocre quality measures – most of which have been in the toolkit since 1992 – which have virtually stopped improving [graphic]. On how patients report their experience of care, the numbers haven’t moved since the turn of the century [graphic]. Not much more needs to be said on cost – but this snapshot [graphic] reminds us that medical costs are still running about three times higher than general inflation – and for American business, that portends eventual disaster.

Likewise, our insurance rates continue to rise. Last year in Massachusetts many insurance companies requested state approval for rate increases, which were rejected by Governor Patrick. The appeals court ruled that these hikes weren’t the insurance carriers’ fault, but were reasonable given what plans had to pay doctors and hospitals. Here in California, we’ve seen persistent premium hikes directly tied to increases in provider prices, that are simply passed on to purchasers and consumers by the health plans.

So the PBGH journey of the past decade or so, where we’ve been – frankly - complaining from the back seat about the way our health plan partners are driving, seems to be “at a dead end.” We purchasers aren’t making much headway by asking the plans to behave differently, and the plans don’t seem too motivated to change their behavior anyway. It’s time to continue our journey to a high-performing health care system by another route.

To start down this new road, we at PBGH are shifting more of our energy to a provider-facing strategy. We have had limited success relying on the plans to hold providers' feet to the fire to improve quality and control costs. So now we are cautiously optimistic that some of the new models of care delivery will both inspire and compel providers to rethink the ways they deliver care and control costs. If they are structured properly, Accountable Care Organizations (ACOs) are one example of a new model that offers promise because it makes a group of providers directly responsible for the quality and cost of care for given group of patients. Some of our members have also developed innovative ways to work closer with providers. For example, Safeway shares information about the cost of a common procedure -- a colonoscopy -- at local facilities with its employees, urging them to choose the lower cost option.

As we head down this new road our engine is powered, in large part, by data. We need and continue to seek more data about performance and cost at the facility and individual physician level. Securing this data can be challenging, as we saw last year when California Medical Association sued Blue Shield for its Blue Ribbon recognition program, which relies on provider level data to champion high performing physicians.

The road ahead surely has bumps, but we are energized and optimistic that the next decade will be different than the last. It is time health care quality and costs started heading in the right direction.

About the Author

David Lansky, Ph.D.

President & Chief Executive Officer, Pacific Business Group on Health

David Lansky, PhD, is the President and Chief Executive Officer of the Pacific Business Group on Health (PBGH) and directs its efforts to improve the affordability and availability of high quality health care. View full bio »